- Humana (Raleigh, NC)
- **Become a part of our caring community and help us put health first** The Utilization Management Registered Nurse 2 utilizes clinical nursing skills to ... independent determination of the appropriate courses of action. The Utilization Management Registered Nurse...skills to make an impact** **Required Qualifications** + **Licensed Registered Nurse ( RN )** in the… more
- UNC Health Care (Raleigh, NC)
- …of care and cost effectiveness through the integrating and functions of case management , utilization review and discharge planning. The Care Manager ... of employment date. **Licensure/Certification Requirements:** * Licensed to practice as a Registered Nurse in the state of North Carolina. **Professional… more
- CVS Health (Raleigh, NC)
- …affordable. **Position Summary:** This is a full-time telehealth role for a Registered Nurse with **Virtual Group Coaching and Telehealth experience required.** ... regulatory and accreditation guidelines **Required Qualifications** - Must be an Registered Nurse with **Virtual Group Coaching Presentation** experience for… more
- Highmark Health (Raleigh, NC)
- …and Sunday required in addition to 3 weekdays** This job implements effective utilization management strategies including: review of appropriateness of ... and offers interventions and/or alternatives. **ESSENTIAL RESPONSIBILITIES** + Implement care management review processes that are consistent with established… more
- Sharecare (Raleigh, NC)
- …appropriate total healthcare management and ensure cost effective, appropriate resource utilization and quality outcomes. The RN is also responsible for ... and their Primary Care Provider according to the disease management program intervention guidelines. An RN is...orientation and to take the pre and posttests to review competency during orientation. Yearly competency test is required… more
- Highmark Health (Raleigh, NC)
- …Remote - Part Time - Weekends Required.** This job implements the effective utilization management strategies including: review of appropriateness of health ... and offers interventions and/or alternatives. **ESSENTIAL RESPONSIBILITIES:** + Implement care management review processes that are consistent with established… more
- UNC Health Care (Raleigh, NC)
- …cost effectiveness through the integrating and functions of point of entry case management , utilization review , and effective patient flow activities. ... position is to enhance the quality of inter-hospital transfer management and satisfaction and to promote continuity of care...Requirements:** * Must be licensed to practice as a registered nurse in the state of North… more
- CVS Health (Raleigh, NC)
- …more personal, convenient and affordable. **Position Summary** **This is a fully remote Utilization Management opportunity.** Utilization management is a ... **Required Qualifications** + 3+ years of experience as a Registered Nurse + Must have active current...in EST or CST + Managed Care experience + Utilization review experience **Education** + Minimum of… more
- Guardian Life (Raleigh, NC)
- …services. Act as a liaison between all parties required in case management to facilitate collaboration toward RTW goals. Utilization of independent ... **Position Summary** The RN Clinical Consultant serves as a clinical resource...issues, when possible, to enhance the customer experience. **Activity** Review and assess claimant subjective reports and objective medical… more
- UNC Health Care (Rocky Mount, NC)
- …Summary: Facilitates effective and cost-efficient care of patients through such case management functions as utilization review and discharge planning. ... reviews for private insurance companies, Medicare and Medicaid, in accordance with utilization review guidelines. Tactfully and effectively informs Manager of… more
- Evolent (Raleigh, NC)
- …Doing:** As a Clinical Reviewer, Nurse , you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... Clinical Reviewers are supported by Field Medical Directors (MDs) in the utilization management determination process. + Reviews charts and analyzes clinical… more
- United Therapeutics (Raleigh, NC)
- …Degree preferably in a health, biological sciences, or related field or + Registered Nurse ( RN ) nursing qualifications or relevant clinical research ... with superior financial performance and our communities with earth-sensitive energy utilization . Our company was founded by an entrepreneur whose daughter was… more